Doctors at Portlaoise hospital have put forward a compromise plan to the complete withdrawal of the key critical care ICU unit.
Dr Susan O'Reilly, Dublin Midlands Hospital Chief has said the low volume of cases going through the unit at the Midlands Regional Hospital Portlaoise means it cannot be sustained in the long run.
Without an ICU the hospital cannot continue to provide maternity, paediatrics, surgery and emergency services.
In their alternative plan, Portlaoise hospital's consultants say critical care helps people with life-threatening illnesses. In the absence of contingency for safe and effective critical care, acute clinical care cannot be provided.
They say MRH Portlaoise Critical Care Unit is a Category 2 ICU. The unit can accommodate either four HDU or two ventilated patients. The critical care unit is staffed by the anaesthetic department. The anaesthetic team also support the obstetrics, general surgery, cardiology and mental health services at MRH Portlaoise.
Between 40-50 patients annually require the life-saving intervention of invasive ventilation. A further 200 adult patients receive ICU/HDU care.
The critical care team also carry out the initial stabilisation of critically-ill children prior to the involvement of the Paediatric Intensive Care retrieval team.
"This critical care resource is an essential safeguard; were it to cease, acute care could no longer take place on site," say the doctors.
The doctors acknowledge that the throughput of ventilated patients may be low by national levels, but few post-operative patients require ventilation in Portlaoise and these cases would account for most of the patients requiring such care in many units with similar overall activity to MRH Portlaoise.
The doctors say that Acute Medicine Programme sets out two options for critical care support.
Category 1 ICU: ‘Invasive ventilatory support (48-72 hours), earlier transfer if severe critical illness’
Category 2 ICU: ‘General critical care, multi-organ failure support incl CRRT (Continuous Renal Replacement Therapy)
The Acute Medicine Programme further recommends:
‘For the safe and prompt regional or supra-regional transfer of critically ill patients within the hospital models system, a critical care retrieval team service is required.’
"We recommend that the current Critical Care unit at MRH Portlaoise be re-configured as a Category 1 ICU".
As a Category 1 ICU, the doctors say the ICU would continue to provide life-saving treatment on a 24/7 basis, for patients who become critically unwell while in hospital or who present critically ill to the hospital.
However, they say the focus would change and no longer would the patient’s ICU stay in its entirety be expected to be completed at MRH Portlaoise.
Rather, the doctors suggest that initial care, including stabilisation and establishment of ventilatory support, would take place at MRH Portlaoise with subsequent care taking place after transfer to a Category 2 or 3 ICU unit.
The consultant proposed that this transfer would be sought should invasive ventilatory support be required for longer than 24 hours, or immediately if complex or interdisciplinary intervention was required or deemed likely to be required.
The alternative plan says anaesthetic team would continue to fulfill its current service commitments, in particular, for example, to the operating theatres, the surgical, maternity and paediatric departments.
"We recommend that functioning reliable networks and pathways be established through shared appointments and protocol-led seamless patient transfers with a regional Category 2 or 3 ICU," says the plan.